TMJ/TMD Temporomandibular Disorders

Headache and Neck Pain Relationship

As many as 2 out of 10 people who suffer from a chronic headache may have neck related headaches and it may be as high as 4 out of 10 in women. There are many ways neck pain can turn into Headache pain. The muscles under the base of the skull can refer pain to the head. In addition a cervical disc problem and/or neck joint irritation can cause pain to radiate, causing a headache.

We know there are many types of headaches, but there are commonly 3 types of headaches that have evidence linking headache and neck pain: Tension, Migraine and Cervicogenic can all be directly related to the neck.

Tension

The most common type of headache is the tension headache. It is estimated that 80 to 90 percent of the population suffer from tension headaches at least some time in their lives.

Signs and Symptoms include: Dull, non-throbbing pain, frequently bilateral, associated with tightness of scalp, neck and shoulder muscles. In addition, sensation of tightness or pressure across your forehead or on the sides and back of your head. Degree of severity remains constant.


Tension headaches are divided into two main categories — Episodic and Chronic.

  • Episodic tension headaches: Episodic tension headaches can last from 30 minutes to a week. Frequent episodic tension headaches occur less than 15 days a month for at least three months. These tension headaches may become chronic.
  • Chronic tension headaches: This type of tension headache lasts hours and may be continuous. If your headaches occur 15 or more days a month for at least three months, they’re considered chronic.
Migraine

This is the second most common type of headache. Around 16 to 17 percent of the population complains of migraines. These headaches are far more debilitating than the typical tension type headache and are usually unilateral and pulsating (hallmark sign).

The most common migraine symptoms are:

  • Throbbing, pulsating pain – 85 percent
  • Light sensitivity – 80 percent
  • Sound sensitivity – 76 percent
  • Nausea – 73 percent
  • Pain on one side – 59 percent
  • Vision changes, blurred vision – 44 percent
  • Aura – 36 percent
  • Vomiting – 29 percent
(Note: These figures are from the American Migraine Study II of almost 4,000 migraine sufferers in 1999)
Tension Headaches vs Migraines

Tension headaches can be difficult to distinguish from migraines. Plus, if you have frequent episodic tension headaches, you can also have migraines. Unlike some forms of migraine, tension headaches usually aren’t associated with visual disturbances, nausea or vomiting. Although physical activity typically aggravates migraine pain, it doesn’t make tension headache pain worse. An increased sensitivity to either light or sound can occur with a tension headache, but these aren’t common symptoms.

Cervicogenic

Directly neck related headaches. They get their name from cervico (cervical or neck) and genic (generated), so neck generated headache.

Neck Pain

Of course, neck pain can present with and without headache . A stiff neck is typically characterized by soreness and difficulty moving the neck, especially when trying to turn the head to the side. A stiff neck may also be accompanied by a headache, neck pain, shoulder pain and/or arm pain.

Muscle Strain or Sprain

By far the most common cause of a stiff neck is a muscle strain or soft tissue sprain of the muscles around the neck.

Cervical Spine Disorders

Many problems in the cervical spine can lead to neck stiffness. The stiffness can be a reaction to the underlying disorder in the cervical spine. Several examples of common cervical spine disorders include:

  • Cervical Herniated disc
  • Cervical Degenerative Disc Disease
  • Cervical osteoarthritis—which often occurs along with other degenerative conditions, such as spinal stenosis, and anatomical changes, such as bone spurs.
Nerve Entrapment Disorders

These disorders include anything that encroaches or compresses on a nerve as it exits the area of the cervical spine. Symptoms include pain that can start at the neck and travel to the arm or hand, numbness or tingling that may be from the neck to the hand, muscle weakness that can occur in any muscle that is innervated by the nerve, and loss of range of motion in the neck.

Thoracic Outlet Disorders

Thoracic outlet syndrome is a painful condition that results from compression of the nerves and/or blood vessels running through the thoracic outlet (area between the top rib and collarbone). The symptoms are typically felt in the shoulder and arm, but sometimes can also be felt in the neck.

Common Causes of Neck Pain and Headaches
  • Sleeping with the neck at an awkward position that strains the neck muscles
  • Sports Injuries that strain the neck, such as a fall or sudden impact that pushed the head to the side.
  • Poor posture, such as slouching while viewing the computer monitor or looking downward at a mobile phone for prolonged periods. Holding the neck in an abnormal position for a long period, such as cradling a phone between the neck and shoulder.
  • Excessive stress, which can lead to tension in the neck
  • Repetitive motions. Turning the head in a repetitive manner, such as side to side while dancing or swimming, may lead to overuse of the neck’s muscles, tendons, and ligaments.
  • Whiplash. In a whiplash injury, the head and neck are forced suddenly forward and immediately backward with a great deal of force. The soft tissues along and near the cervical spine can be torn or ruptured as a result. This type of injury commonly occurs in an auto accident that involves a rear-end collision.
Temporomandibular Joint (TMJ) Pain:
  • Does your jaw pop or click when you open your mouth?
  • Do you have jaw or face pain?
  • Do you clench or grind your teeth and does this cause pain?

Temporomandibular Disorders are a complex and poorly understood set of conditions characterized by pain in the jaw joint and surrounding tissues and limitation in jaw movements. Injuries and other conditions that routinely affect other joints in the body, such as arthritis, also affect the Temporomandibular Joint. Most jaw joint and muscle problems, are of unknown cause. Because the condition is more common in women than in men, scientists are exploring a possible link between female hormones and TMJ disorders.

  • Symptoms: A muscle-contraction type of pain, sometimes accompanied by a painful “clicking” sound on opening of the jaw. Other symptoms include radiating pain in the face, jaw, or neck, Tinnitus (ringing of the ears), jaw muscle stiffness, feelings of dizziness or disequilibrium, Ear pain (otalgia), Sinus pain or pressure, Headache, and limited movement or locking of the jaw.
  • Precipitating Factors: Caused by malocclusion (poor bite), stress, and jaw clenching
How Can Physical Therapy Help?

Manual Therapy

Hands on manual therapy provides relaxation, restores joint mobility and aides in improving muscle length and improved posture.


Posture and Body Mechanics

Posture and body mechanic improvements help speed recovery and prevent long term recurrence.


Home Exercise Program

Here is an example of a possible home office neck and shoulder stretch.


Therapeutic Taping

Kinesiotape used to inhibit (relax) muscle tension or facilitate weak muscles.


Neck pain, TMJ pain and the above-described types of headache pain usually respond well to:

  • Neck Exercises
  • Posture correction methods including ergonomics when sitting and working
  • Stress reduction techniques
  • Direct muscle massage treatment of the area where the muscles attach
  • Cranial Sacral Therapy
  • Trigger Point Dry needling
    • A 2015 article indicated that trigger points can create nervous system changes and are able to reproduce headache patterns of migraine, crevicogenic and tension headaches. The author indicates treating these muscle areas may have positive effects for these headaches
  • Myofascial Release
  • Joint Mobilization
  • Cervical Traction

Physical Therapy Your Way – Advanced Specialty Care have experienced staff with extensive continuing education in the treatment of headaches including many advanced manual therapy treatment skills which have proven effective in treating the above diagnoses. For more information about the treatment options listed and additional information on Headache, Neck Pain, and TMJ pain schedule an appointment today and start the road to recovery. For additional information on the therapist that treat these conditions please see the links listed below.

Head and Neck Pain Specialists

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